Dementia and Alzheimer’s Disease

Dementia symptoms vary depending on the cause, but common signs and symptoms include:

• Cognitive changes
• Memory loss, which is usually noticed by a spouse or someone else
• Difficulty communicating or finding words
• Difficulty with visual and spatial abilities, which may lead to getting lost
• Difficulty reasoning or problem-solving
• Difficulty handling complex tasks
• Difficulty with planning and organizing
• Difficulty with coordination and motor functions
• Confusion and disorientation
• Psychological changes
• Personality changes
• Depression
• Anxiety
• Inappropriate behaviour
• Paranoia
• Agitation
• Hallucinations

Seek a medical opinion if you or a loved one has memory problems or other dementia symptoms. Some treatable medical conditions can cause dementia symptoms, so it is important to determine the underlying cause. 

Dementia is caused by damage to or loss of nerve cells and their connections in the brain. Symptoms depend on the area of the brain that is affected by the damage.

Alzheimer’s disease is the most common cause of a progressive dementia in older adults, but there are several causes of dementia. 

Some diseases with dementia-like symptoms, such as those caused by a reaction to medications or vitamin deficiencies, might improve with treatment.

Dementias may be classified by the protein or proteins deposited in the brain or the part of the brain that is affected.

Progressive (non-reversible) dementias include:

• Alzheimer’s disease – plaques and tangles of distinctive proteins can be detected in the brain. It is thought that these clumps damage healthy neurons and the fibres connecting them. Not all causes of Alzheimer’s disease are known, but genetic factors have been identified.

• Vascular dementia – the second most common type of dementia, caused by damage to the vessels that supply blood to the brain. The most common symptoms of vascular dementia include difficulties with problem-solving, slowed thinking, focus and organization. These tend to be more noticeable than memory loss.

• Lewy body dementia – one of the more common types of progressive dementia. Abnormal balloon like clumps of protein (Lewy bodies) have been found in the brains of people with Lewy body dementia, Alzheimer’s disease and Parkinson’s disease. Common signs and symptoms include acting out one’s dreams in sleep, visual hallucinations, and problems with focus and attention. Other signs include uncoordinated or slow movement, tremors, and rigidity (parkinsonism).

• Frontotemporal dementia – a group of diseases characterized by the degeneration of nerve cells and their connections in the frontal and temporal lobes of the brain, the areas generally associated with personality, behaviour and language. Common symptoms affect behaviour, personality, thinking, judgment, and language and movement.

• Mixed dementia is the name given to dementia thought to be due to a combination of several causes, such as Alzheimer’s disease, vascular dementia and Lewy body dementia. 

Other disorders linked to dementia include:

• Huntington’s disease – a genetic mutation causes certain nerve cells in the brain and spinal cord to waste away. Signs and symptoms, including a severe decline in thinking (cognitive) skills, usually appear around age 30 or 40.

• Traumatic brain injury (TBI) due to repetitive head trauma can cause dementia signs and symptoms such as depression, explosiveness, memory loss and impaired speech. TBI may also cause parkinsonism. Symptoms might not appear until years after the trauma.

• Creutzfeldt-Jakob disease – rare brain disorder which usually has no known cause but can be inherited. Signs and symptoms of this fatal condition usually appear after age 60.

• Parkinson’s disease may lead to the development of dementia symptoms (Parkinson’s disease dementia).

Some causes of dementia or dementia-like symptoms can be reversed with treatment. They include:

• Infections and immune disorders
• Metabolic problems and endocrine abnormalities
• Nutritional deficiencies
• Medication side effects
• Subdural hematomas
• Poisoning
• Drug or alcohol abuse
• Brain tumours 
• Anoxia or hypoxia where oxygen supply to the brain is compromised
• Normal-pressure hydrocephalus

Diagnosing dementia and its type can be challenging. More recently, biomarkers have become available to make a more accurate diagnosis of Alzheimer’s disease.

Your doctor will review your medical history and symptoms and conduct a physical examination. He or she will likely ask someone close to you about your symptoms as well.

Multiple tests may be required, as no single test can diagnose dementia:

• Cognitive and neuropsychological tests to assess thinking skills, such as memory, orientation, reasoning and judgment and language skills
• Neurological evaluation to evaluate memory, language, visual perception, attention, problem-solving, movement, senses, balance and reflexes
• CT scan or MRI of the brain to check for evidence of stroke or bleeding or tumour or hydrocephalus
• PET scans can show patterns of brain activity and whether the amyloid protein, a hallmark of Alzheimer’s disease, has been deposited in the brain
• Blood tests can detect physical problems that can affect brain function, such as vitamin B-12 deficiency or an underactive thyroid gland
• Sometimes the spinal fluid may be examined for infection, inflammation or markers of some degenerative diseases
• A psychiatric evaluation can determine whether depression or another mental health condition is contributing to your symptoms

Most types of dementia cannot be cured, but there are ways to manage your symptoms.

Several dementia symptoms and behaviour problems might be treated initially using non-medication approaches, such as:

• Occupational therapy and modifying the home environment – with the aim of preventing accidents, such as falls, adapting daily tasks, and managing behaviour
• Monitoring systems can alert if the person with dementia wanders
• Structure and routine also help reduce confusion in people with dementia

Medications may be used to temporarily improve dementia symptoms:

• Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon) and galantamine (Razadyne), work by boosting levels of a chemical messenger involved in memory and judgment
• Memantine (Namenda) works by regulating the activity of glutamate, another chemical messenger involved in brain functions, such as learning and memory

Your doctor might prescribe medications to treat other symptoms or conditions, such as depression, sleep disturbances, hallucinations, parkinsonism or agitation.

Therapies may help reduce agitation and promote relaxation in people with dementia.

• Music therapy
• Light exercise
• Watching videos of family members
• Pet therapy or gardening therapy
• Massage therapy and aromatherapy
• Art therapy

Research into dementia is ongoing.  Currently, here is no sure way to prevent dementia, but some healthy lifestyle changes may be beneficial:

• Keep your mind active with activities such as reading, solving puzzles, playing word games, and memory training 
• Be physically and socially active
• Quit smoking
• Eat a healthy diet with sufficient vitamins
• Manage cardiovascular risk factors – high blood pressure, high cholesterol, diabetes.